INDIANA STATE VENDOR FORMS The attached forms must be completed to become a vendor of the state: 1. W9 2. Direct Deposit 3. FSSA Provider Data Form These forms must be completed by the Early Childhood Program providing services for Pre-K Pilot Program. Legal name on W9 must match the Direct Deposit form (Corporations cannot have individual as legal name). Address must match on both forms and voided check Classification box must be marked All documents must be signed by authorized person. No stamped or computer generated signatures accepted May attach voided check (same information as W9) or have your financial institution complete section #2 with signature and appropriate box checked. Please follow the directions included for each form. Completed forms may be mailed to: Office of Early Childhood and Out of School Learning 402 West Washington Street W-361 MS-02 Indianapolis IN 46204-2739 Attention: Beth Barrett Forms can also be faxed to 317-234-6905-attention Beth Barrett.
